Oral Fluoroquinolone Therapy for Clostridium difficile Enterocolitis-Reply

Abstract

In Reply.— The observations of Dr Lettau, while anecdotal, are of great interest because they suggest that treatment with an oral fluoroquinolone (ciprofloxacin) may allow the resolution of symptoms ofC difficiletoxin-positive diarrhea that resulted from use of another antibiotic (ceftriaxone). These observations require verification in a controlled manner and may even warrant a controlled trial of a fluoroquinolone agent for the treatment ofC difficilediarrhea. As Dr Lettau correctly points out, the diarrhea may have resolved simply as a result of discontinuation of ceftriaxone therapy. In our therapeutic trial we observed cessation of diarrhea without treatment in 34 of 149 patients within 48 to 72 hours after discontinuation of the offending antibiotic.1Discontinuation of antibiotic therapy remains the first choice for treatment ofC difficile-associated diarrhea. We reserve metronidazole or vancomycin therapy for seriously ill patients or for those whose diarrhea does not resolve after